not a harmless drug: prevention and treatment of marijuana ... · • already readily available,...
TRANSCRIPT
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Not a Harmless Drug: Prevention and Treatment of
Marijuana Addiction
Kevin P. Hill, M.D., M.H.S. 10/25/13, Rhode Island Student Assistance
Services Conference
McLean Hospital Division of Alcohol and Drug Abuse Treatment [email protected]
Supported by NIDA K99/R00 DA029115 (Kevin P. Hill, MD, MHS, PI) and the Adam Corneel Young Investigator Fellowship from McLean Hospital to Dr. Hill.
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Disclosure
I have no financial relationship with a commercial entity producing health-care related products and/or services.
Meda Pharmaceuticals has graciously agreed to provide some of the medications used in our studies.
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Three Areas of Focus
• Clinical work: consult service, private practice.
• Clinical research: 3 clinical trials (2 marijuana, 1 tobacco cigarettes).
• Educational outreach: Science vs. public perception, official community partner to Boston Public Schools.
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The Marijuana Issue is Not Black and White- There is Gray.
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Large Numbers, Disturbing Trend
Monitoring the Future 2012
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• Adult Chemical Dependency Questionnaire
• If progression to “hard” drugs takes place, it happens very quickly.
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Why So Complicated?
• Can’t paint with a broad brush.
• Many misguided by their own experiences.
• Math can be tricky.
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Marijuana in the Northeast- A
Trend Toward Increased Access
• Decriminalization of less than 1 ounce in 2008 (MA) and 2013 (RI).
• Medical Marijuana passed in November 2006 (RI), 2012 (MA).
• Trend toward making marijuana more available; legalization by 2016?
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How much is an ounce?
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Today’s Marijuana is Not Like Marijuana of the Past
• Extremely potent (15-22% THC) marijuana available.
• Medical marijuana laws have created legitimate farms growing potent strains.
• Is this new marijuana more addictive?
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Easier, Stronger, Cheaper • Already readily available, marijuana easier
to get.
• Extremely potent marijuana engineered to increase THC/CBD ratio.
• Now around $400 an ounce, the price will likely go down for marijuana of comparable potency.
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Marijuana Myths
• Not harmful
• Not addictive
• No withdrawal
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Cannabis / Marijuana
• Many consider this a “soft” drug.
• No overdose potential.
• We need to move the discussion along so that people think marijuana—like alcohol– is dangerous.
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IT IS HARMFUL!
• Early onset leads to poor cognitive function (Pope 2003, Gruber 2011)
• anxiety (Crippa 2009)
• depression (Degenhardt 2003)
• risk of psychosis (Kuepper 2011, Large 2011)
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Teen Marijuana Use May Permanently Reduce IQ
• Dunedin (NZ) birth cohort- 1037 subjects.
• Multiple interviews, neuropsych at 13, 38.
• Aimed to test association between persistent cannabis use and neuropsychological decline.
Meier et al. 2012
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Supports Other Work Detailing Harms of Marijuana Upon the Developing
Brain • Persistent use associated with
broad neuropsych decline.
• Regular use before 18 associated with worsening performance.
• Cessation for 1 year did not fully restore function.
Meier et al. 2012
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IT IS ADDICTIVE!
Drugs of abuse increase DA in the Nucleus Accumbens….triggers the
neuroadaptions that result in addiction?
150 125 100
0 20 40 60 80
MARIJUANA
% o
f Bas
al R
elea
se
0 100 200 300 400 500 600 700 800 900
1000 1100
0 1 2 3 4 5 hr
AMPHETAMINE
% o
f Bas
al R
elea
se
0
50
100
150
200
0 60 120 180 Time (min) %
of B
asal
Rel
ease
Empty Box Feeding
Di Chiara et al.
FOOD Tanda, et al, Science 1997.
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There is Withdrawal! (Vandrey et al., 2005; Vandrey et al. 2008, Budney et al., 2009)
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Medical Marijuana in the Northeast
• Reality– the Genie is out of the bottle.
• Well-intentioned regulations with troublesome areas.
• Work from the Northeast, along with that from states like Colorado, might inform modifications.
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Studying the Effects of MMJ in MA
• Survey study- change in access and indications.
• THC content and genetic tracking.
• There are enough people guessing, we are aiming to use scientific rigor to see what actually occurs.
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Clinical Research
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• 7 participants completed trial (58.3%).
• Significant reduction in cigarette smoking.
• Non-significant reduction in marijuana smoking, but perhaps a trend.
• This group is treatable!
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Clinical Research
• No FDA-approved medications for marijuana addiction.
• Agonist treatments similar to nicotine patch or suboxone.
• Separate studies with nabilone and dronabinol.
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What do you do?
• Never worry alone.
• McLean, primary care physician, school nurse.
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What does treatment look like?
• Medical detox is not necessary.
• 30 days of “rehab” is unlikely.
• Get prospective patient to talk to somebody.
• Readiness/alliance work, followed by a program or outpatient psychotherapy .
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Critical Period
• More education needed- can we at least get people to think of marijuana like they do alcohol?
• Trends are ominous.
• NIDA and some foundations have invested in these ideas.
• Thank you for doing the work that you do everyday!
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Acknowledgments • Scott Lukas • Roger Weiss • Shelly Greenfield • Garrett Fitzmaurice • Staci Gruber • Lindsay Toto • George Trksak • John Rodolico • Dave Penetar • Max Hurley-Welljams-Dorof • Alan Budney
• NIDA • NARSAD • McLean • HMS • Meda Pharmaceuticals • McLean IRB • FDA • DEA
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Contact
• Clinical/Education: [email protected]
• 617 855 4501
• Research screening line: 617 855 2359.